Prioritizing Quality Improvement for the Treatment of Psychiatric Disturbances Following Traumatic Brain Injury

 描述（由申请人提供）：此K 01申请旨在为申请人成功的，独立资助的研究生涯做好准备，应用利益相关者参与的方法来调查创伤的流行病学，特别是TBI后的精神障碍。创伤性脑损伤（TBI）后的精神障碍（如抑郁、焦虑和创伤后应激障碍（PTSD））与认知和功能恢复较差相关，有效的治疗可能会改善结局。拟议研究的长期目标是推进以患者为中心的TBI后精神障碍治疗结果研究，以提高护理质量。本申请的主要目的是优先考虑患者选择的策略，以克服TBI后接受精神障碍治疗的障碍。 具体目标是：1）评估以患者为中心的障碍和促进治疗的比较治疗和患者群体; 2）评价目前的治疗模式和比较安全性与治疗TBI后的精神障碍;和3）优先考虑患者选择的策略，以克服障碍，接受治疗的具体比较治疗和人群。将采用两种方法来确定TBI后三种最常见的精神障碍（抑郁、焦虑和PTSD）接受治疗的障碍和促进因素。我将实施患者参与方法的培训，并与我的PCOR咨询委员会和导师合作，以确定和招募患者合作伙伴，包括TBI患者，他们的家庭成员和医疗保健提供者。我们将使用焦点小组和访谈来评估比较治疗和患者组中以患者为中心的治疗障碍和促进因素，并确定用于比较安全性分析的精神障碍的比较治疗。接下来，我将量化与TBI后三种最常见的精神障碍相关的治疗模式的差异，并进行比较安全性分析，以确定定义的亚组之间治疗风险的变化。最后，我将与我的PCOR咨询委员会合作，优先考虑患者选择的策略，以克服TBI后接受精神障碍治疗的障碍。拟议的研究采用最好的定性和定量的方法来评估TBI后精神障碍的治疗。TBI患者将成为研究咨询委员会的一部分，该委员会将积极参与整个研究过程，并将推动研究问题。这项研究的意义在于，它将通过优先考虑患者选择的策略来克服接受治疗的障碍，并提供有关治疗模式和当前药物治疗安全性的必要信息，从而提高TBI后精神障碍患者的护理质量。

 DESCRIPTION (provided by applicant): This K01 application is designed to prepare the applicant for a successful, independently-funded research career applying methods of stakeholder engagement to investigate the epidemiology of trauma, specifically psychiatric disturbances following TBI. Psychiatric disturbances such as depression, anxiety, and post- traumatic stress disorder (PTSD) following traumatic brain injury (TBI) are associated with poorer cognitive and functional recovery and efficacious treatment would likely improve outcomes. The long term goal of the proposed research is to advance the conduct of patient-centered outcomes research on treatment for psychiatric disturbances following TBI to improve the quality of care. The primary objective of this application is to prioritize patient-selected strategies to overcome barriers to receipt of treatment for psychiatric disturbances following TBI. The specific aims are: 1) Assess patient-centered barriers and facilitators of treatments across comparator treatments and patient groups; 2) Evaluate current treatment patterns and comparative safety associated with treatment of psychiatric disturbances following TBI; and 3) Prioritize patient-selected strategies to overcome barriers to the receipt of treatment for specifi comparator treatments and populations. Two approaches will be employed to identify barriers and facilitators of the receipt of treatment for the three most common psychiatric disturbances following TBI (depression, anxiety, and PTSD). I will implement training in methods of patient engagement and work with my PCOR advisory committee and mentors to identify and recruit patient partners, including individuals with TBI, their family members, and healthcare providers. We will use focus groups and interviews to assess patient-centered barriers and facilitators of treatments across comparator treatments and patient groups and identify comparator treatments for psychiatric disturbances for comparative safety analyses. Next, I will quantify disparities in treatment patterns associated with the three most common psychiatric disturbances following TBI and perform comparative safety analyses to identify variation of treatment risk among defined subgroups. Finally, I will work with my PCOR advisory committee to prioritize patient-selected strategies to overcome barriers to the receipt of treatment for psychiatric disturbances following TBI. The proposed research employs the best of qualitative and quantitative approaches to assess the treatment of psychiatric disturbances following TBI. Patients with TBI will form part of a research advisory committee that will be actively engaged throughout the research process and will drive research questions. The significance of this research is that it will improve the quality of care for patients with psychiatric disturbances following TBI by prioritizing patient-selected strategies to overcome barriers to the receipt of treatment, and providing needed information on treatment patterns and safety of current pharmacologic treatments.